Doppler blood flow changes and placental morphology in pregnancies with third trimester hemorrhage

Combined real-time ultrasound and pulsed Doppler ultrasound examinations were performed in 67 patients with third trimester hemorrhage and other symptoms related to placental abruption, starting from the onset of symptoms to delivery. In 52 of the cases, placental morphology was investigated by light microscopy. Thirteen patients were ultimately given the diagnosis abruptio placentae. None of the morphological placental changes considered had any statistical relationship to placental abruption. Patients with placental centrocotyledon hemorrhages and infarction more often had abnormal umbilical artery flow velocity waveforms at the onset of symptoms, and more frequent abnormal arcuate artery flow velocity waveforms were found among those with placental infarction alone. Abnormal flow velocity waveforms in the umbilical and arcuate arteries were associated with placental abruption, both at the onset of symptoms and at the final examination before delivery. The results indicate an increased risk for placental abruption if the arcuate and/or umbilical artery flow velocity waveforms are abnormal in patients with third trimester hemorrhage

Waveform Pattern Recognition – A New Semiquantitative Method for Analysis of Fetal Aortic and Umbilical Artery Blood Flow Velocity Recorded by Doppler Ultrasound

A semiquantitative computerized waveform pattern recognition system for analysis of the fetal descending aortic and umbilical artery Doppler flow velocity waveforms is presented. Based on empirically and manually selected clinical recordings from both vessels, 11 computerized and normalized standard curves for the aorta (type curves A to K), and 10 curves for the umbilical artery (type curves a to j) were constructed. The best match between the normalized waveform and the standard curve was based on either the degree of absent diastolic flow or, in cases with positive diastolic flow, on the calculation of the least square sum of the difference. The pattern recognition was tested against conventional waveform indices and our older semiquantitative Blood Flow Class (BFC) system in 472 clinical consecutive Doppler recordings. A good correlation was found. This new relatively simple computer-based method for waveform analysis is now prospectively applied in clinical studies

Massive feto-maternal hemorrhage: diagnosis by cardiotocography, Doppler ultrasonography and ST waveform analysis of fetal electrocardiography.

A 34-year-old healthy gravida 2 para 1 presented after an uncomplicated pregnancy at term with a 2-day history of diminished fetal movements. Fetal anemia was suspected by fetal heart rate monitoring and Doppler estimation of the fetal peak blood flow velocity of the middle cerebral artery. We were also fortunate to register pathological ST waveform changes of the fetal ECG indicating fetal hypoxia. The diagnosis of a massive feto-maternal hemorrhage was confirmed by an extremely high fraction of erythrocytes containing fetal hemoglobin in maternal blood and, after delivery, by placental histology. Copyright (c) 2006 S. Karger AG, Basel

Coronary Flow in Neonates with Impaired Intrauterine Growth.

BACKGROUND: Subclinical myocardial injury has been reported in newborns with fetal weights < 2 SDs for gestational age. Intrauterine growth restriction might affect cardiac function and coronary flow (CF). METHODS: Seventeen newborns with intrauterine growth restriction and 15 age-matched healthy controls were enrolled in the study. Blood flow in the umbilical artery and maternal uterine artery was assessed using Doppler velocimetry. Cardiac function and left anterior descending coronary artery CF were measured using transthoracic Doppler echocardiography at 1 week of age. RESULTS: The mean growth deviation of the newborns from normal was -2.5 ± 0.2 SDs. Percentage left ventricular shortening fraction was 39 ± 4.3% in patients and 42 ± 4.1% in controls (P = .40), and the mean left ventricular mass index was 86.6 g/m(2) in patients and 73.7 g/m(2) in controls (P < .01). The mean left anterior descending coronary artery diameter was 0.99 ± 0.1 mm in patients and 0.8 ± 0.1 mm in controls (P = .002). The left anterior descending coronary artery flow velocity-time integral was correlated with left ventricular mass index (r = 0.31, P = .007) and with mitral peak E/A ratio (r = 0.74, P = .01). Intrauterine growth restriction was associated with increased peak flow velocity in diastole (34.5 ± 4 vs 19 ± 6 cm/sec in controls, P = .0001), as well as increased CF (37 ± 7.3 vs 8.2 ± 3.0 mL/min in controls, P = .001). CONCLUSIONS: CF is significantly increased in neonates with impaired intrauterine growth. Left ventricular mass index is increased, but systolic and diastolic function remains normal. The clinical significance of increased CF is unclear, but it might lead to decreased CF reserve

Early intervention in management of very preterm growth-restricted fetuses : 2-year outcome of infants delivered on fetal indication before 30 gestational weeks

OBJECTIVES: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.METHODS: Between 1998 and 2004, 42 fetuses with intrauterine growth restriction (IUGR) and ARED in the umbilical artery were delivered liveborn by Cesarean section on fetal indication before 30 gestational weeks. The median gestational age at delivery was 27 + 1 (range, 24 + 4 to 29 + 5) weeks. An additional four fetuses died in utero at a median gestational age of 24 + 2 (range, 23 + 5 to 25 + 4) weeks. Neonatal morbidity, infant mortality and major neurological morbidity of liveborn infants were compared with those in two control groups: all 371 liveborn infants delivered at 0.05).CONCLUSIONS: Very preterm growth-restricted fetuses with umbilical artery ARED delivered on fetal indication, in most cases before the occurrence of severe changes in the ductus venosus velocity waveforms and/or fetal heart rate tracings, showed high 2-year survival and low morbidity

Investigation of the fetal heart circulation in an animal model using contrast enhanced ultrasound

To assess the distribution of blood from the umbilical vein (UMV), inferior vena cava (IVC) and superior vena cava (SVC) to either side of the fetal lamb heart by using ultrasound enhanced contrast agent imaging. By injection of ultrasound contrast agents (UCA) in UMV, IVC or SVC, the blood from these vessels was tracked, as it then was highly echogenic. By evaluating the image intensity within the heart ventricles, the relative concentrations of blood could be determined. The study was performed in 19 near term fetal lambs of mixed breed, with a mean gestational age of 136 days (range 134-136). Ultrasound contrast agent was injected at a constant rate of 1 ml/min, to ensure that a constant level of contrast agent would be obtained in both sides of the heart. Results: the median percentages of blood distributed to the left ventricle when injecting contrast in UMV, IVC, and SVC, was 68%, 67%, and 21% respectively. These numbers compare well with previously published data, except the recorded percentage distributed from the IVC. This could be a methodological error as well as a result of the mild hypoxia, or an actual increased capacity of the left ventricle at this gestational ag

OP14.12: Outcome after active delivery before 30 gestational weeks of pregnancies complicated by fetal growth restriction and ARED flow.

Abstract is not availabl